Global Point Prevalence Survey of

Antimicrobial Consumption and Resistance in hospitals worldwide

Ann Versporten

prof. Oyinlola Oduyebo

prof. Herman Goossens University of Antwerp, Belgium

College of Medicine, Lagos, Nigeria

Dedicated to the entire

Global-PPS network !

What is Surveillance

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World Health Organization:

Systematic ongoing collection, collation, and analysis of

data and the timely dissemination of information to those

who need to know so that action can be taken.

U.S. Centers for Disease Control and Prevention:

The ongoing systematic collection, analysis, and

interpretation of health data, essential to the planning,

implementation, and evaluation of public health practice,

closely integrated with the timely dissemination of these

data to those who need to know.

Antibiotic prescribing in hospitals - What does the literature offer ?

Wide range of methods, with different numerators and denominators, which makes comparison difficult

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Vials

Treatment periods

Defined Daily Doses

(DDD)

Defined Daily

Administration (DDA)

Antibiotic days or Days of

Treatment (DOT)

Prescribed Daily Dose

(PDD)

Courses

Patients

Agent Days

Nominators Denominators

All inpatients

All days of therapy

occupied bed-days

discharges

Total population

All admissions

All prescribed daily doses

administrative bed-days

Patient days

All prescriptions

Standardized approach Collect and report consistent, valid

and comparable antimicrobial prescribing & resistance data amongst hospitalized adults, children and neonates

Compare and analyze trends over time in a uniform way

Above all: a simple method Feasible, achievable surveillance

An innovative worldwide accessible web-based Global-PPS TOOL

Evaluate the situation in your hospital : determine quantity and quality of antimicrobial prescribing in hospitals

Identify targets to improve quality of antimicrobial prescribing

Assess effectiveness of interventions through repeated PPS.

Increase public health capacity.

Combat antimicrobial resistance.

Aims Global-PPS and impact on AMR

What we freely offer:

• Protocol, different languages • Data collection templates : ward and patient form (paper) • Web-based data-entry and verification through the Global-

PPS programme, including validation (quality assurance) and reporting (real-time feedback with benchmarking national and worldwide) (http://www.global-pps.com/documents/)

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- One-point feedback report - Longitudinal feedback report - Raw data in excel

• Full support to the hospitals : all materials, PPT slides on the method used (EN, FR), FAQ list, IT manual, posters, leaflets to promote the study, …, and help desk !

Degree of participation or enrollment as of today

N = 96 countries

N ≈ 1000 hospitals

N ≈ 220,000 admitted patients

Antimicrobial use prevalence (%) by UN-region, 2015 and 2017 (country-ranges)

Europe

Asia

Continuous work towards

sustainability and scale up

through COMMUNICATION

and NETWORKING

ECCMID 2016

Support towards analyses and

communication of own results

Global-PPS in Ghana presented as poster at the 10th European Congress on Tropical

Medicine and International Health

See: www.global-pps.com/dissemination/

Final results presented during ECCMID 2016 and ECCMID 2018

Brochure including each 22 communications

Global and local publications and communications on-going

Global PPS 2015 and 2017

Scientific papers using Global-PPS data

www.global-

pps.com/dissemination/

peer-reviewed-articles/

Networking : Global-PPS as intermediary

• Regional coordinators !

Connect new partners/participants

• E.g. Global-PPS expert from Singapore went to the Philippines and Myanmar to train a hospital network under lead of MoH

www.global-pps.com/supporting-organizations/

• Contract signed with

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Lessons learned

Global-PPS offers a tool to measure AMU, a first step in the fight against antimicrobial resistance

This simple method provides a feasible & achievable surveillance

Enormous opportunity to stimulate local networking and collaboration

Mutual cooperation and feedback is highly motivating.

Communications to stakeholders, politicians

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Challenges

For the participants:

• Workload and time constraints, manpower, resources (Evaluation of the Global-PPS through Survey Monkey questionnaire)

• Knowledge on interpretation of the feedback report and raw data in excel.

• What next ?? How to enhance practice changes?

For Global-PPS team:

• Global-PPS continuously grows !

Manpower to deal with requested

help from participants !!

Solutions What we continuously do

• Help making meaningfull presentations • Help searching for feasible targets to work on • Help writing up research (abstract, paper, any

other communication) • Help networking : link up professionals • Help making participants to shine, to show their

work, get appreciated for efforts

Solutions

Under development , foreseen for 2019 :

• Health Care Associated Infection (HAI) module

• Aid towards setting up sustainable antimicrobal stewardship activities adapted to local needs

Development of survey to assess impact of Global-PPS on stewardship activities, the needs and barriers with specific focus on LMIC

Practical E-learning module (hands-on cases)

Sharing of experiences, networking, capacity building !

www.global-pps.com Contact global-PPS@uantwerpen.be

Any hospital is welcome to

join the Global-PPS

network

Supporting healthcare professionals

in the fight againstresistance

The Nigerian

Global-PPS

experience Global-PPS and

Antimicrobial

Stewardship

(AMS) in NIGERIA

What global PPS means to Nigeria

• Tool for a realistic and sustainable AMS

• Entry point and monitoring tool for AMS in Nigeria

• The Nigerian working group on AMS

– Hospitals participating in Global-PPS

– Came into being in August 2018

– Published a communiqué

– Another meeting in November 2018

– AMS still young in Nigeria

How it all began

LUTH story till 2015 Global PPS

Plan of our hospital antimicrobial stewardship committee

• 2012: Set up of antimicrobial stewardship program

• Subcommittee to develop a proposal to obtain baseline information for our stewardship program.

• Barrier : There was no funding for the project

Situation till the advent of the global point prevalence survey of antimicrobial consumption and resistance (GLOBAL -PPS) in 2015.

• LUTH participated to the 2015 Global-PPS and were able to obtain data we considered enough to start the hospital stewardship program

LUTH story: Global-PPS in 2015, 2017 & (2018)

• We identified issues – Very high rates of antimicrobial prescribing – Under-utilisation of the clinical microbiology labs – No information on MDROs – No antibiotic guidelines – Negative prescribing habits

Hospital antibiotic policy written

based on Global-PPS data

Similar issues identified in all Global-PPS participating

NIGERIAN hospitals !

Awareness has been created in

the country about global-PPS

making AMS feasible

EDUCATION AND AWARENESS MADE SOME DIFFERENCE IN OUR HOSPITAL

Tertiary care hospital Lagos Intervention in

2016

Tertiary care hospital Abuja

No Intervention

2015 2017 2015 2017

Antibiotic prevalence adult wards 80.6% 67.0% 58.7% 61.2%

Antibiotic prevalence in pediatric wards 89.7% 59.2% 50.9% 68.3%

Surgical prophylaxis ≥24h 93.0% 100% 90% 100%

Targeted prescribing 8% 1% 22% 3%

Guidelines missing: medical adult wards 96.7% 100% 21.9% 50.0% surgical adult wards 97.9% 99.2% 6.0% 27.3%

medical pediatric wards 100% 100% 21.2% 70.0%

Reason for prescribing written in notes 42.2% 42.0% 54.3% 52.1%

Stop review date documented 16.2% 16.7% 38.3% 36.3%

Overview of the quantity and quality of

antimicrobial prescribing in two Global-

PPS participating Nigerian hospitals

Following dissemination of Global-PPS data

• Interventions planned separately for each department because of the large hospital size

(761 beds)

• Started with Paediatrics department in 2016

Paediatrics

• Disseminated data at clinical meeting

– Wrote antibiotic guidelines

Took one year to write

– Chose an antibiotic team

– Chose a strategy

Prospective audit with intervention and feedback

• Challenge: manpower (seen as extra work)

– Feasibility of prospective audit with intervention and feedback with medical students confirmed

Prospective audit with intervention and feedback in LUTH Paediatrics

• Every prescription is audited with a checklist • Checklist is based on hospital antibiotic policy

and dept antibiotic guideline • Checklist completed by

– Medical students – Clinical pharmacologists from the university college

• decide appropriateness based on checklist – Consultants in the ID unit/Stewardship team

• do the feedback to prescribers

• Monitoring and evaluation by Hospital stewardship committee

AMS in NIGERIA today

• Participating to global-PPS – 4 hospitals in 2015 – 10 hospitals in 2017 – 13 hospitals have

registered in 2018

• 3 hospitals have started formal stewardship program

• Hospitals doing PPS came together to form the National working group for AMS in Nigeria – Communique – Working on a plan of action

Benefit of conducting Global-PPS in LMIC

• AMS strategies may be cumbersome for resource poor countries especially those without good laboratories – hence no AMS

• It is a good tool for beginners of AMS • It allows you to identify prescribing problems

and identify solutions tailored for your peculiar issues

• It also makes AMS monitoring possible

LUTH ANTIMICROBIAL STEWARDSHIP COMMITTEE APPRECIATES GLOBAL-PPS

Disclosures

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Supporting healthcare professionals

in the fight against resistance

“bioMérieux is the sole private sponsor of the GLOBAL Point Prevalence Survey. The Global-PPS is also funded by a personal

Methusalem grant to Herman Goossens of the Flemish government.

The funder has no role in study design, data collection, data analysis, data interpretation, or writing the report.

Data are strictly confidential and stored anonymously at the

coordinating centre of the University of Antwerp.”